June 28 - 29, 2007 Advisory Committee Meeting Minutes

Mental Health

Dr. Dishman was asked to discuss issues the Committee should be aware of concerning mental health.

Mental health problems are prevalent, costly, contribute to disability and reduced quality of life. Many studies address this but they are not uniform in quality and quantity across population sub-segments. Most of the data is recent so problems interpreting earlier data versus recent data may not be as problematic in mental health.

Methodological issues to consider from observational studies include the fact that a large portion of the data comes from archival studies not designed to directly test the relations of mental health and physical activity. There is also concern across age groups pertaining to the use of questionnaires for the mental health variables that are really measures of symptoms that may have differing relative importance depending on age groups. Additionally, there are no studies looking at the impact of reducing symptoms in healthy folks for preventing subsequent diagnosis as well as virtually no evidence on the impact of reducing symptoms in diagnosed folks or reducing the risk of secondary occurrence.

Some excluded topics to reconsider and/or flag for Phase B include childhood cognitive function literature and studies on physical activity in an acute setting on mental health or mood.

Discussion among the Committee included the relationship of acute effects and behavioral issues. For example, a behavioral barrier to exercise is the perception an individual needs to wait to receive a benefit while the benefit is more of a series of repeated acute effects.

Subsequent comments from the Committee centered on exposures that will reduce the level of a certain trait or something in a person that hasn't reached a disease level yet. The data should be portrayed in the proper context that we do not have the evidence and that indeed the reduction symptoms in arbitrarily defined healthy folks have not yet been shown to reduce the incidents of the arbitrarily defined diagnosis.

A question was asked regarding where Alzheimer's and multi-infarct dementia as well as mind/body exercise types such as Tai Chi fit. While there may not be sufficient data available linked to mental health anything that can help inform their benefit should be included.

Regarding repeated acute effects versus chronic adaptations and the relationship of enjoyment there is loose terminology used by investigators leading to serious interpretation issues. Similarly, fatigue is another area in cancer survivors where there is substantial evidence from randomized control trials that physical activity reduces subjective feelings of fatigue; however, a challenge in this area is that much of the data is from self-report methodologies.

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